Appendicitis Flashcards
What is the caecum?
Pouch like structure located in the beginning of the large intestine, where the small intestine (ileum) empties into the colon
How does the caecum play a role in the digestive system?
Absorbing fluids and salts that remain after digestion and mixing the remaining waste with mucus
What does the appendix do?
Produces and transports mucus as part of its role
Appendix help in mucus production. How?
Inner lining of appendix contains goblet cells
Mucus helps to lubricate the contents of the appendix and protect its inner surface
Mucus secreted by goblet cells is transported, where to?
Into the lumen - cavity inside the appendix
What does the mucus aid in moving?
Waste materials and bacteria through the appendix and eventually into the caecum where it enters the large intestine
Appendix has a role in immune function. How?
Maintain a healthy balance of gut bacteria by trapping pathogens and facilitating their removal
What is appendicitis?
Inflammation of the appendix and it typically occurs when the appendix becomes blocked which leads to infection
What is the most common cause of the appendix?
Blockage at the opening of the appendix where it connects to the caecum
When there is blockage, what can this lead to?
Fecaliths (hard stool) - hardened stool can obstruct the appendix
Enlarged lymphoid tissue - appendix can swell due to infection (GI and Resp infections) causing obstruction
Foreign objects or parasites - foreign materials or parasites can block the appendix
When there is a bacterial infections, what happens to the appendix?
Bacteria multiply inside it, causing infections.
Leads to swelling, pus formation and increased pressure within the appendix
If an inflamed appendix is not treated, what can happen?
Can lead to a rupture of the appendix
This can cause the infection to spread into the abdomen
This can result in a condition called peritonitis
What is a rare case of appendicitis?
Tumours
What is blocked when the appendix are obstructed?
Mucus outflow - but the body keeps producing it
This then distends the appendix and then bacteria builds up
What is sent to your brain when you have appendicitis?
Visceral nerve fibres is small and thus a generic stimuli of pain is sent to the brain
This can happen when there is pressure on the LRQ
When the pressure builds up during appendicitis, what happens to the appendix and what does it cause?
- Blood flow is affected to the organ
- This causes severe pain, infection, tissue decay and perforation
What is the risk when the appendix perforates?
The contents (bacteria, faecal matter, mucus, pus) spill into the abdominal cavity causing peritonitis
The pain for appendicitis progress over how long?
4-6 hours
What age for M and F is it more common in?
11 - 20 = female
21 - 30 = male
What are the tests for Appendicits?
- McBurney’s
- Psoas sign
- Oturator sign
- Rovsing’s sign
What is the location of McBurney’s Point
Located about 1/3 of the way along line from the right anterior superior iliac sign to the umbilicus
What is the procedure for McBurney’s?
Palpates on the point to assess for tenderness or pain
What are the signs of a positive McBurney’s Point Test?
- Severe localised pain is an indication of acute appendicitis
- Rebound tenderness - applies pressure and quickly releases. Increased pain upon releasing the pressure it suggests peritoneal irritation - appendix inflamed or ruptured
What is the Psoas’s sign?
- Tests for inflammation near the right iliopsoas muscle
- This muscle can become irritated when the appendix is inflamed or particularly in cases of retrocecal appendicitis - appendix positioned behind cecum
What is the positioning for Psoas Sign?
Usually laying on their back. supine
Or on their left side
What are the two procedures for Psoas
Passive extension method (more common):
- Lies on their back while the healthcare worker gently extends the patients right leg at the hip joint keeping the knee straight
- This stretches the psoas muscle
Active flexion method:
- Patient lies on their left side and HC worker extends the right lack backwards asking the patient to actively lift the right leg against resistance
- Flexing the hip contracts the psoas muscle
What are the signs of a positive Psoas sign?
- Pain in LRQ
Why is the Psoas sign useful?
- Help diagnosing retrocecal appendicitis
- Help differentiate appendicitis from other causes of abdo pain - especially absent of McBurney’s
The Obsturator Sign, what does the test for?
Irritation of the obturator internus muscle which can be affected when an inflamed appendix is in its close proximity
What is the position for the Obturator Sign Test ?
Lies on their back - supine
What is the procedure for Obturator Sign Test ?
- HC worker provider lifts the patients right leg and flexes the hip and knee to 90 degrees (bending the leg at the hip and knee)
- Then the HC worker internally rotates the hip gently moving patients ankle outwards while keeping the knee stationary
- Movement stretches the obturator internus muscle
What is a positive sign for the Obturator Sign Test ?
- Pain in lower abdomen - RLQ
- Pain occurs because of the internal rotation of the hip causes the obturator internus muscle to rub against the inflamed appendix especially if the appendix is located in the pelvis or the LRQ
Why is the Obturator Sign Test useful?
- Helpful when appendix is in the pelvis or if there is suspicion of pelvic appendicitis
- Helps pinpoint location of inflammation
What is the Rovsing’s Sign?
- Referred pain in the RLQ
What is the procedure for the Rovsing’s Sign?
- HC worker applies deep pressure to the LLQ
- Pressure gradually released while observing patients response
What is a positive Rovsing’s Sign ?
- Patient feels pain in the RLQ when pressure is applied or released from the LLQ
- Pain occurs due to the shifting of gas or the movement of the peritoneum which causes irritation of the inflamed appendix on the right side
